Project Summary Nearly 1/5 of the 230,000 annual births to teen mothers in the US are repeat births (births to a teen mother who already has one or more children), the large majority of which are unintended. Repeat teen mothers are a high-risk group of adolescents; they are more likely to drop out of high school, are less likely to be employed, and more likely to have mental health problems, and start prenatal care later or receive no prenatal care more frequently compared to first-time teen and older mothers. They also experience higher incidence of preterm birth, low infant birth weight, and infant mortality compared to both first time teen mothers and older mothers. Despite the vulnerability of these mothers and their children, they have been notably understudied compared to first-time teen mothers. The demographic composition of this population, their health profile, their knowledge and attitudes toward contraceptive are not well documented. We also lack understanding of the processes by which teens choose their contraception, knowledge that is necessary to inform appropriate education and facilitate uptake of effective contraception among teen mothers wishing to prevent a repeat birth. The proposed research has 3 aims: 1. Characterize the US repeat teenage mother population with regards to demographic characteristics, reproductive health, and contraceptive use and compare this population to first time teen mothers and older mothers (ages 20-25). 2. Identify individual factors that influence teens' desire to use long acting reversible contraceptives (LARCs) in high- and low-access states, Colorado and Texas. 3. Identify knowledge, attitudes, intentions, and perceived accessibility regarding postpartum contraception, particularly LARCs, among teens. This award will provide training and mentorship to Dr. Julie Maslowsky, a developmental psychologist and population health scientist at the University of Texas at Austin, in demography, adolescent reproductive health and sexual behavior, and qualitative research methods to complement her existing expertise in adolescent development, population health, and quantitative methods. The training and research experience will prepare Dr. Maslowsky to be an independent scientist producing a program of novel, high- impact research on adolescent reproductive health. The results of the proposed research will yield novel insights into the population composition of repeat teen mothers, their health profile, and their knowledge, attitudes, and experiences regarding contraception. Such insights are a necessary first step to fill the current gap in policy and practice around repeat births to teen mothers. Ultimately, this research will inform successful provision of effective contraception to teen mothers who desire it in order to reduce the number of unintended repeat teenage births and ultimately lead to healthier mothers and babies across the nation.